title: Endoscopic versus histological characterisation of polyps during screening colonoscopy.
abstract: BACKGROUND
  As screening colonoscopy becomes more widespread, the costs for histopathological assessment of resected polyps are rising correspondingly. Reference centres have published highly accurate results for endoscopic polyp classification. Therefore, it has been proposed that, for smaller polyps, the differential diagnosis that guides follow-up recommendations could be based on endoscopy alone.
  
  
  OBJECTIVE
  The aim was to prospectively assess whether the high accuracy for endoscopic polyp diagnosis as reported by reference centres can be reproduced in routine screening colonoscopy.
  
  
  METHODS
  Ten experienced private practice endoscopists had initial training in pit patterns. Then they assessed all polyps detected during 1069 screening colonoscopies. Patients (46% men; mean age 63 years) were randomly assigned to colonoscopy with conventional or latest generation HDTV instruments. The main outcome measure was diagnostic accuracy of in vivo polyp assessment (adenomatous vs hyperplastic). Secondary outcome measures were differences between endoscopes and reliability of image-based follow-up recommendations; a blinded post hoc analysis of polyp photographs was also performed.
  
  
  RESULTS
  675 polyps were assessed (461 adenomatous, 214 hyperplastic). Accuracy, sensitivity and specificity of in vivo diagnoses were 76.6%, 78.1% and 73.4%; size of adenomas and endoscope withdrawal time significantly influenced accuracy. Image-based recommendations for post-polypectomy surveillance were correct in only 69.5% of cases. Post hoc analysis of polyp photographs did not improve accuracy.
  
  
  CONCLUSIONS
  In everyday practice, endoscopic classification of polyp type is not accurate enough to abandon histopathological assessment and use of latest generation colonoscopes does not improve this. Image-based surveillance recommendations after polypectomy would consequently not meet guideline requirements.
  NCT01297712.
authors.affiliation: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, , Hamburg, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Schachschal
authors.forename: Michael
authors.initials: M
authors.lastname: Mayr
authors.forename: Andras
authors.initials: A
authors.lastname: Treszl
authors.forename: Klaus
authors.initials: K
authors.lastname: Balzer
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Jens
authors.initials: J
authors.lastname: Aschenbeck
authors.forename: Alireza
authors.initials: A
authors.lastname: Aminalai
authors.forename: Rolf
authors.initials: R
authors.lastname: Drossel
authors.forename: Andreas
authors.initials: A
authors.lastname: Schröder
authors.forename: Mathias
authors.initials: M
authors.lastname: Scheel
authors.forename: Carl-Hermann
authors.initials: CH
authors.lastname: Bothe
authors.forename: Jens-Peter
authors.initials: JP
authors.lastname: Bruhn
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Burmeister
authors.forename: Gabriela
authors.initials: G
authors.lastname: Stange
authors.forename: Christina
authors.initials: C
authors.lastname: Bähr
authors.forename: Ralf
authors.initials: R
authors.lastname: Kießlich
authors.forename: Thomas
authors.initials: T
authors.lastname: Rösch
mesh_terms: D018256:Adenomatous Polyps / Q000473:pathology* / Q000601:surgery; D000368:Aged; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery; D003111:Colonic Polyps / Q000473:pathology* / Q000601:surgery; D020685:Colonoscopes; D003113:Colonoscopy / Q000295:instrumentation / Q000379:methods; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
keywords: Colonic Polyps; Colorectal Adenomas; Differentiation; Screening